Non-lens-based surgical techniques for presbyopia correction | Archivos de la Sociedad Española de Oftalmología (English Edition)

 array:24 [
  "pii" => "S2173579417301494"
  "issn" => "21735794"
  "doi" => "10.1016/j.oftale.2017.04.004"
  "estado" => "S300"
  "fechaPublicacion" => "2017-09-01"
  "aid" => "1195"
  "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "ssu"
  "cita" => "Arch Soc Esp Oftalmol. 2017;92:426-35"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0365669117301545"
      "issn" => "03656691"
      "doi" => "10.1016/j.oftal.2017.04.005"
      "estado" => "S300"
      "fechaPublicacion" => "2017-09-01"
      "aid" => "1195"
      "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "ssu"
      "cita" => "Arch Soc Esp Oftalmol. 2017;92:426-35"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 73
        "formatos" => array:2 [
          "HTML" => 58
          "PDF" => 15
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "T&#233;cnicas quir&#250;rgicas no cristalinianas para la correcci&#243;n de la presbicia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "426"
            "paginaFinal" => "435"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Non-lens-based surgical techniques for presbyopia correction"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0050"
            "etiqueta" => "Figura 10"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr10.jpeg"
                "Alto" => 1271
                "Ancho" => 950
                "Tamanyo" => 120635
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">a y b&#41; Expansores esclerales&#58; se insertan bandas de silicona en 4 canales esclerales para incrementar la distancia entre el ecuador cristaliniano y la esclera suprayacente&#44; implementando la contracci&#243;n del m&#250;sculo ciliar&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "R&#46; Bilbao-Calabuig, F&#46; Llovet-Osuna"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Bilbao-Calabuig"
              ]
              1 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Llovet-Osuna"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173579417301494"
          "doi" => "10.1016/j.oftale.2017.04.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301494?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117301545?idApp=UINPBA00004N"
      "url" => "/03656691/0000009200000009/v1_201708280004/S0365669117301545/v1_201708280004/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173579417300786"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2017.03.018"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1058"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2017;92:436-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "PDF" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>"
      "titulo" => "Unilateral corneal edema caused by a hidden foreign body"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "436"
          "paginaFinal" => "438"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Edema corneal unilateral causado por un cuerpo extra&#241;o oculto"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 838
              "Ancho" => 2998
              "Tamanyo" => 196752
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Foreign body in right eye anterior chamber angle&#44; with adjacent anterior synechia&#46; &#40;C&#41; The foreign body was surgically extracted through inferior sclerocorneal incision&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46; Galvis, A&#46; Tello, G&#46;A&#46; Frederick, A&#46;N&#46; Laiton"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Galvis"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Tello"
            ]
            2 => array:2 [
              "nombre" => "G&#46;A&#46;"
              "apellidos" => "Frederick"
            ]
            3 => array:2 [
              "nombre" => "A&#46;N&#46;"
              "apellidos" => "Laiton"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S036566911630096X"
        "doi" => "10.1016/j.oftal.2016.06.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566911630096X?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300786?idApp=UINPBA00004N"
    "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300786/v2_201708291316/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173579417300737"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2017.03.013"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1151"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2017;92:419-25"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "425"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Caracter&#237;sticas cl&#237;nicas y microbiol&#243;gicas en queratitis infecciosas bacterianas en un hospital de tercer nivel"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1300
              "Ancho" => 2102
              "Tamanyo" => 133243
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Risk factors&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;M&#46; Ruiz Caro, L&#46; Cabrejas, M&#46;R&#46; de Hoz, D&#46; Mingo, S&#46;P&#46; Duran"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Ruiz Caro"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Cabrejas"
            ]
            2 => array:2 [
              "nombre" => "M&#46;R&#46;"
              "apellidos" => "de Hoz"
            ]
            3 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Mingo"
            ]
            4 => array:2 [
              "nombre" => "S&#46;P&#46;"
              "apellidos" => "Duran"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0365669117300266"
        "doi" => "10.1016/j.oftal.2017.01.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300266?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300737?idApp=UINPBA00004N"
    "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300737/v2_201708291316/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Non-lens-based surgical techniques for presbyopia correction"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "426"
        "paginaFinal" => "435"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "R&#46; Bilbao-Calabuig, F&#46; Llovet-Osuna"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "R&#46;"
            "apellidos" => "Bilbao-Calabuig"
            "email" => array:1 [
              0 => "rbilbao&#64;clinicabaviera&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "F&#46;"
            "apellidos" => "Llovet-Osuna"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Unidad de Cirug&#237;a Refractiva y Cataratas&#44; Cl&#237;nica Baviera Madrid&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "T&#233;cnicas quir&#250;rgicas no cristalinianas para la correcci&#243;n de la presbicia"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Fig&#46; 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 643
            "Ancho" => 800
            "Tamanyo" => 58056
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Intracor technique &#40;Technolas Perfect Vision&#44; Germany&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Presbyopia is the most frequent refractive error in people over 40 years of age&#46; It is estimated that over one billion have presbyopia throughout the world&#44; and many deal with it with hypo-correction or no correction at all&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">1</span></a> Even so&#44; presbyopia correction without recourse to spectacles or contact lenses is at present a huge challenge both for refractive ophthalmological surgeons as well as for the millions of patients who endure this disorder&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Physiology of accommodation and presbyopia</span><p id="par0010" class="elsevierStylePara elsevierViewall">It is known that the amplitude of subjective accommodation diminishes with age&#46; Starting from the highest values in childhood where up to 15 diopters &#40;D&#41; of accommodation can be achieved&#44; the capacity of this biomechanical process diminishes in a linear&#44; universal and quite predictable manner up to the appearance of astenopia and blurred vision in the middle age&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">2</span></a> Despite over one century of research&#44; the exact mechanisms of accommodation and presbyopia remain controversial&#46; In the young human eye&#44; the majority of changes measured <span class="elsevierStyleItalic">in vivo</span> have demonstrated that&#44; in response to the ciliary muscle contraction&#44; lens thickness increases&#44; lens diameter diminishes and the anterior as well as posterior lens curvatures also increase&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">3&#44;4</span></a> With age&#44; viscoelastic properties and lens rigidity undergo changes&#46; On the other hand&#44; lens diameter grows approximately 20<span class="elsevierStyleHsp" style=""></span>&#956;m every year of human life&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Surgically&#44; there are 3 main categories&#58; in the first place&#44; lenticular-capsular theories based on the loss of elasticity of the lens capsule and progressive sclerosis and rigidity of the aging lens&#59; in the 2nd place&#44; extra-lenticular theories that consider contractility of the ciliary body as the main cause of presbyopia&#59; and finally the geometric theory that explains presbyopia due to the diminishing of the distance between the equatorial edge of the lens and the ciliary body&#44; which in turn diminishes zonular tension&#46; There is a certain overlap between the first and the third etiology category&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">6</span></a> Schachar believes that the effective force that the ciliary muscle can apply at the lens equator diminishes linearly with age and that this is the main cause of presbyopia&#46; Scleral expansion surgery for treating presbyopia<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">7&#44;8</span></a> is based on said theory&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical options for correcting presbyopia</span><p id="par0020" class="elsevierStylePara elsevierViewall">Numerous surgical procedures have been described for offsetting presbyopia&#44; each one with its advantages and drawbacks&#44; generally involving a compromise between near and far vision&#46; Accommodative techniques endeavor to restore the true continuous and dynamic focusing capacity of the eye&#46; Pseudo-accommodative surgeries provide functional near vision for patients with various non-accommodative mechanisms&#46; Of these&#44; the most widely utilized are the stenopeic hole&#44; a certain degree of residual corneal myopia or astigmatism and corneal multifocality with high order aberrations &#40;such as spherical aberration or coma&#41; that enable field amplitude increases to improve near vision&#46; Finally&#44; individual patient skills&#44; motivations and expectations could play a role in their ability to recover near vision&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical strategies for treating presbyopia are generally extraocular &#40;corneal or scleral&#41; or intraocular&#44; acting over the presbyopic lens of patients&#46; The present article is an updated review of non-lens surgical techniques&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Corneal procedures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Excimer laser monovision</span><p id="par0030" class="elsevierStylePara elsevierViewall">Excimer laser monovision is a well established and known technique previously utilized for correcting presbyopia by means of spectacles and contact lenses &#40;CL&#41;&#46; One eye is corrected for far vision &#40;usually the dominant eye&#41; while the other is corrected for intermediate-near vision &#40;with a final spherical equivalent of approximately &#8211; 1&#46;25<span class="elsevierStyleHsp" style=""></span>D&#41;&#44; intentionally creating tolerable anisometropia&#46; The physiological mechanism accounting for the success of monovision is the ocular suppression of blurred images&#46; This is an excellent option for many presbyopia patients&#46; The objective is to achieve functional far &#40;FVA&#41;&#44; intermediate &#40;IVA&#41; and near &#40;AVC&#41; visual acuity without requiring the use of spectacles&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">9&#8211;11</span></a> The majority of patients adapt well to this degree of anisometropia&#44; with very few dysphotopsia events and maintaining a certain degree of stereopsis in addition to preserving some reversibility&#46; In situations where high precision vision is required&#44; patients can improve their vision with the temporary use of spectacles&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Some studies have reported success and satisfaction rates between 80 and 98&#37; with monovision after Excimer laser correction&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#8211;14</span></a> of 91&#37; after cataract surgery and 95&#37; after lens refractive interchange &#40;LRI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">15</span></a> It is surprising that postsurgical monovision with Excimer laser exhibits a higher rate of success compared to contact lenses &#40;about 70&#8211;75&#37;&#41;&#44; but it is difficult to determine whether this is due to the relative irreversibility of a surgical procedure&#44; to the discomfort related to the use of contact lenses or to the degree of corneal multi-focality achieved with Excimer laser&#46; The latter technique is well accepted by the majority of patients&#44; excepting those with significant anisometropia or clear ocular dominance or by those having poor stereopsis&#44; all of these being factors that inhibit ocular suppression&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">16</span></a> Generally&#44; women adapt to this technique better than men&#44; with more satisfactory outcomes at earlier stages of presbyopia due to the higher permanence of lens accommodative functions&#46; It can also be achieved inducing myopia in the dominant eye &#40;crossed monovision&#41;&#44; with similar results being reported for both alternatives&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Recently&#44; a technical modification has been described for an Excimer laser platform &#40;Presbyond Laser Blended Vision&#44; Carl Zeiss Meditec&#44; Germany&#41; in which the eye receives an ablation with an optimized profile that endeavors to increase corneal spherical aberration to increase field depth&#46; This is added to monovision in the reading eye and micro-monovision in the dominant eye&#44; in order to improve efficacy and tolerance vis-&#224;-vis conventional monovision&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;19</span></a> In fact&#44; this procedure is half way between conventional monovision and mini-monovision&#44; performed with improved corneal abrasion profiles still having some room for improvement and which consequently shares many of the advantages as well as drawbacks of the technique&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Limitations of monovision are due to the alterations it produces in some visual functions&#46; Fundamentally&#44; patients present visual acuity reductions in low contrast conditions&#44; as well as diminished contrast sensitivity and stereopsis&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> In addition&#44; it requires very high precision in the ametropia to be achieved in the far vision eye&#44; leading to a higher incidence of retreatments&#44; particularly in hypertropics&#46; It requires frequently extended presurgery examinations and post-surgery adaptation&#44; besides being limited in time due to the progressive deterioration of lens function&#46; Even so&#44; it is a very simple&#44; satisfactory&#44; safe&#44; efficient and predictable technique which&#44; as it does not induce significant corneal aberration&#44; will not entail significant limitations in the choice of intraocular lens &#40;IOL&#41; for future lens surgery&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Multifocal corneal ablations &#40;commonly known in the literature as presbiLASIK&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The floating dot technology of current Excimer laser devices has enabled a huge amount of flexibility in ablation patterns for molding the cornea&#46; Corneal multifocality achieved with these devices was initially very attractive for surgeons due to the familiarity with existing photoablation techniques&#44; the lower invasiveness of an extraocular technique and the alleged higher technical precision&#46; A range of multifocal corneal ablation patterns have been described&#44; all of them focused on modifying spherical aberration in order to increase focal amplitude&#44; even at the expense of impairing visual quality&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">21</span></a> In theory&#44; these patterns should obtain better stereopsis than with VC because the images of both eyes are very similar&#46; Two techniques&#44; central presbiLASIK and peripheral presbiLASIK&#44; have been widely studied and have accumulated more evidence for achieving uncorrected near and far functional vision&#44; minimizing inherent contrast sensitivity and visual quality impairment&#46; The results and application of these techniques largely depend on the technical characteristics of the laser platforms&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In peripheral presbiLASIK&#44; the peripheral cornea is ablated to create negative asphericity&#46; Thus&#44; the central cornea is utilized for far vision and the middle periphery cornea for near vision &#40;for example&#44; Nidek Advanced Vision&#44; Nidek Co&#46; LTD&#44; Gamagori&#44; Japan&#41;&#46; The main limitation of peripheral presbiLASIK lies in the relatively large amount of ablated corneal tissue required to create a hyperprolate shape&#46; For this reason&#44; this technique is more adequate for hypertrophic than myopic eyes&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In turn&#44; central presbiLASIK produces a small central optical area with higher curvature for near vision&#44; surrounded by a flatter area for far vision &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#44; Supracor Technolas Perfect Vision&#44; Supracor Technolas Perfect Vision GmbH&#44; Munich&#44; Germany&#44; PresbyMax&#44; SCHIWND eye-tech-solutions GmbH&#44; Kleinosthein&#44; Germany&#44; or CustomVue VISX&#44; VISX CustomVue&#44; Santa Clara&#44; USA&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; This technique features less tissue ablation and can be applied after initial myopic or hypertrophic treatment for far vision&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">24&#44;25</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In both types&#44; the most important technical limitation is establishing the most adequate centering axis&#58; the visual or optical axis&#44; or the corneal vertex&#46; In addition&#44; both require sufficient pupil size and dynamics to suit the corneal carving&#46; Finally&#44; both are usually supplemented with a relative degree of mini-monovision for improving far vision results&#46; This technique induces chromatic aberrations that could significantly degrade visual quality&#46; PresbiLASIK seems to be more indicated for patients with incipient presbyopia&#46; However&#44; as presbyopia continues to evolve&#44; the technique diminishes in efficacy&#46; Even though at the optical level published results are optimum and foreseeable&#44; some patients refer difficulties in adaptation and others are dissatisfied with the small induced loss of far vision&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">26</span></a> In addition&#44; when these patients are considered for lens surgery&#44; it would be difficult to calculate the IOL power and the possibilities of implanting a multifocal IOL will be severely limited due to the previous irreversible multifocal corneal ablation&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Notable improvements in multifocal IOL technology and the relatively low surgical risk of LRI in hypertrophic patients have significantly limited the application of presbiLASIK in hypertrophic patients&#46; In presbyopic myopic patients&#44; the regmatogenous risk of LRI makes prebiLASIK a safer option&#46; However&#44; the VC with Excimer laser is an equally safe&#44; effective and well demonstrated option&#46; Pseudophakic patients previously implanted with monofocal IOL could be good candidates for prebiLASIK&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In summary&#44; multifocal corneal abrasions with Excimer laser could have a promising future but at this point in time its application is limited due to its inherently temporary nature and the relatively high associated incidence of visual quality loss and side effects derived from induced corneal multifocality&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;28</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Corneal implants &#40;CI&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Corneal implants &#40;CI&#41; have evolved considerably in the past 20 years&#44; since the implementation of femtosecond laser technology that has enormously facilitated its implementation under lenticules or within corneal pockets&#46; The initial models were doubtful due to biocompatibility issues&#44; although more recent models are thinner and more porous&#44; highly permeable to oxygen and with minimum corneal stromal reactivity&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There are 3 types of CI which&#44; by means of different mechanisms&#44; increase focal depth achieving a pseudo-accommodation effect and thereby improving uncorrected near visual acuity &#40;uNVA&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The 3 types of CI are &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#58;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Implants that alter the refraction index with bifocal optics</span><p id="par0095" class="elsevierStylePara elsevierViewall">Flexivue Microlens &#40;Presbia&#44; Inc&#46;&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; and Icolens &#40;Neoptics AG&#44; Switzerland&#41;&#44; are hydrophilic acrylic implants with refraction indices different to that of the cornea&#46; A small central orifice enables far vision and the peripheral ring with positive power induces a multifocal effect&#44; allowing the patient to obtain relatively good far and near vision&#46; These implants exhibit excellent biocompatibility and&#44; being transparent&#44; do not obstruct light entering the eye&#46; At present they are in clinic trials but with promising results reported for both types after one year follow-up&#44; albeit with a limited number of implanted eyes&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">29&#44;30</span></a> More recently&#44; another study reported more modest results with an explantation rate of 7&#46;4&#37; after 36 months follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">&#43;&#43;&#43;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Implants that change the corneal curvature</span><p id="par0105" class="elsevierStylePara elsevierViewall">Raindrop Near Vision Inlay &#40;ReVision Optics&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41; is small diameter transparent hydrogel CI with hyperprolate form and a refractive index very similar to the corneal index&#46; It modifies the anterior corneal curvature &#40;curving the center&#41; to improve intermediate and near vision&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">32</span></a> It allows complete permeability of corneal nutrients&#46; It is still in clinic trial phase&#46; Initially it was designed to be implanted in the reading eye but it has also been implanted bilaterally leaving 6 months between surgeries with good results in phakic and pseudophakic eyes&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">33&#44;34</span></a> Recently&#44; a study with 373 nondominant implanted emmetropic eyes presented satisfactory functional results after one year&#46; However&#44; 5&#37; had to be substituted due to early decentering problems and a further 3&#37; were expanded&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">35</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Implants that function as a stenopeic hole</span><p id="par0110" class="elsevierStylePara elsevierViewall">Kamra Inlay &#40;Autofocus Inc&#46;&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41; features a small central orifice that enables focus depth increases&#46; Over 20&#44;000 units have been implanted globally and more efficiency and safety data has been published for Kamra than any other type of CI&#46; It is manufactured in an opaque porous material &#40;fluorinated polyvinyledene&#41; with over 8400 micropores to enable free passage of micronutrients through the structure&#46; It must be implanted in a stromal pocket at a depth of at least 220<span class="elsevierStyleHsp" style=""></span>&#956;m or not less than 100<span class="elsevierStyleHsp" style=""></span>&#956;m under the lenticule if associated to LASIK&#46; Several studies have demonstrated satisfactory tolerance and biocompatibility with at least 2 years follow-up&#44; without signs of cicatrization or corneal vascularization&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">36</span></a> Kamra is implanted unilaterally in the nondominant eye which must be emmetropic or minimally myopic&#46; Published studies report sustained improvement in intermediate and near vision without significantly affecting far vision or stereopsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">37&#8211;39</span></a> However&#44; the size&#44; material and visibility of the implant &#40;not only for cosmetic reasons but because it would hinder visibility in future vitreoretinal or cataract surgery&#41; are a disadvantage vis-&#224;-vis other implant types&#46; In addition&#44; it could require a certain neuroadaptation period and some patients refer some degree of glare and halos&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Cis must be implanted in emmetropic eyes and for this reason many eyes require an additional previous refractive procedure&#46; In addition&#44; centering is crucial in all designs to achieve the desired optical effect&#44; and minute displacements could drastically reduce their efficacy&#46; Even so&#44; the learning curve with CIs seems to be somewhat slower than with other refractive surgeries&#46; It could induce corneal aberrations hindering the selection of potency and the IOL model in future lens surgeries and could diminish far vision somewhat&#46; The complications described with Cis include occasional hypermetropization&#44; diminished sensitivity to photopic and scotopic contrast and sporadic cases of corneal migration&#44; thinning and melting as well as infections&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">40</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In summary&#44; Cis exhibit interesting characteristics for treating presbyopia&#44; <span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; their effect is additive and reversible because it can be extracted and repeated&#46; In addition&#44; CIs respect lens function&#44; can be combined with a LASIK&#47;PRK procedure or implanted in pseudophakic eyes with monofocal IOL&#46; But CIs also exhibit clear limitations and drawbacks in some patients depending on the implanted model&#44; including questionable biocompatibility&#44; loss of contrast&#44; far vision and light entering the eye&#44; corneal changes could be permanent&#44; neuroadaptation process is required&#44; could produce halo and glare&#44; the surgical process is more complex due to centering and require previous refractive surgery to achieve emmetropia prior to implant&#46; In addition&#44; their efficacy is usually diminished as presbyopia progresses<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conductive keratoplasty</span><p id="par0125" class="elsevierStylePara elsevierViewall">Conductive keratoplasty &#40;Viewpoint CK System&#44; Refractec Inc&#46;&#44; USA&#41;&#44; the successor of laser thermokeratoplasty&#44; utilizes radiofrequency to modify the corneal contour due to the contraction of corneal collagen around a radioactive probe&#46; Basically&#44; the procedure produces a central curving of the cornea creating a hyperprolate contour with enhanced refractive power &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; The radiofrequency energy is generally 0&#46;6<span class="elsevierStyleHsp" style=""></span>W with a duration of 0&#46;6<span class="elsevierStyleHsp" style=""></span>s&#44; administered with a thin probe applied in the peripheral corneal stroma with a ring pattern outside the patient visual axis&#46; Between 8 and 32 points are applied following a predetermined nomogram in up to 3 peripheral concentric rings located at optical zones of 6&#44; 7 and 8<span class="elsevierStyleHsp" style=""></span>mm&#46; The contraction of the peripheral collagen has the effect of tensing the cornea in the mid periphery which causes a curvature of the central cornea&#46; Although the technique was initially designed for treating slight-moderate hypermetropia&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">41</span></a> it is utilized for presbyopia treating the reading eye and creating monovision&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Even though it is a relatively safe technique with theoretical advantages over corneal photoablation techniques with lenticules &#40;less invasiveness and less complications related to carving&#41;&#44; long-term studies have evidenced a significant rate of regressions&#44;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">42&#44;43</span></a> and at present this technique is virtually discarded&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Intra-stromal corneal incisions with femtosecond laser</span><p id="par0135" class="elsevierStylePara elsevierViewall">Femtosecond laser was initially designed for carving the corneal lenticule during LASIK procedures&#46; However&#44; its safety and precision have enabled the development of new corneal incisional nomograms utilized in the implant of ring segments or intracorneal implants&#44; in relaxing or arched limbic incisions&#44; in different types of keratoplasty as well as for treating presbyopia&#46; The Intracor procedure &#40;Technolas Perfect Vision&#44; Germany&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41; comprises 5 concentric rings of incisions at 2 and 4<span class="elsevierStyleHsp" style=""></span>mm from the visual axis with femtosecond laser&#46; This produces a curving of the central cornea of approximately 1&#8211;2<span class="elsevierStyleHsp" style=""></span>D that induces a modification in spherical aberration and corneal asphericity that account for the improvement of near vision&#46; At present it is performed in the nondominant eye and its main theoretical advantage is the preservation of the corneal surface&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Published results are contradictory&#58; initially it was presented as a very efficient and safe technique&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">44&#44;45</span></a> although studies with longer follow-up periods evidenced some initial regression and significant FCVA&#44;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">46&#44;47</span></a> as well as some published reports of progressive keratectasia&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">48&#44;49</span></a> In addition&#44; its effect on near vision diminishes with time and exhibits the same compromise as other multifocal corneal techniques in the calculation and choice of the lens type to be implanted subsequently during lens surgery&#46; More studies are needed with longer follow-up periods to validate this technique&#44; although its utilization at present is residual&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Scleral procedures</span><p id="par0145" class="elsevierStylePara elsevierViewall">Scleral procedures are physiopathologically founded on Schachar&#39;s accommodation theory&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">7</span></a> This model affirms that during accommodation zonular tension increases at the lens equator&#44; presumably increasing lenticular diameter&#46; Presbyopia would occur as a consequence of progressive lens growth with age&#44; which would reduce the space between the lens and the ciliary muscle &#40;the circumlenticular space&#41;&#46; Accordingly&#44; with ciliary muscle contraction&#44; the zonule would not be able to have the same effect on the lens because it is not completely stretched&#46; Studies made with magnetic resonance &#40;MR&#41; demonstrated that the circumlenticular space does diminish with age&#44; mainly due to lens thickening and centripetal displacement of the ciliary muscle ring&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">50</span></a> However&#44; other studies based on goniovideography&#44; infrared photography and MR have demonstrated that lens diameter and surface diminish during accommodation&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">2</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Despite the significant controversy about his theory&#44; Schachar proposed that by expanding the dimensions of the overlying scleral wall the ciliary muscle would be pulled and separated from the lens equator&#44; thus reverting the process that causes presbyopia and improving accommodational amplitude&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">7</span></a> In the past&#44; scleral techniques included several sclerectomy types with or without silicon or collagen implants&#44; but both were discarded due to risk of ischemia in the anterior ocular segment and scleral macroperforations&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">At present&#44; 2 surgical techniques in the research phase are being applied&#44; both based on said accommodation theory&#46; Their precise action mechanisms are still awaiting elucidation&#46; In the first of said techniques&#44; assisted with an erbium&#58; YAG &#40;Laser Ace System&#44; ACE Vision Group inc&#46; Newark&#44; USA&#41; device&#44; the postulated mechanism would consist in diminishing ocular rigidity through selective ablations of scleral tissue in order to improve scleral flexibility&#44; which in turn would optimize ciliary muscle contractility and thus facilitating accommodation &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">In the second technique&#44; scleral expanders &#40;VisAbility Implant System&#44; Refocus Group&#44; Dallas&#44; USA&#41; modified on the basis of previous models&#44; exert traction on the sclera that supposedly improves accommodation amplitude &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46; Both techniques report improvements in uNVA&#44; and even though they already have been granted certification for the European market&#44; no publications confirming said results are to be found while others&#44; even at this early stage&#44; refer a regression of the initial improvements described in the near vision of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">51</span></a> Moreover&#44; several authors that disagree with Schachar&#39;s accommodation theory dismiss these techniques as completely inefficient&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">52</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">As in all refractive procedures&#44; a presurgery in-depth examination is mandatory and must particularly include a precise evaluation of the quality of the ocular surface and the lacrimal tear as well as a detailed evaluation of topography&#44; thickness and if possible presurgery corneal aberrations&#46; A lens with significant opacity and the absence of relevant optic nerve and retina pathology are also essential&#46; It is frequently necessary to perform trials in different lighting conditions or even in exceptional situations with contact lenses in order to verify patient tolerance to anisometropia and assist the patient in inferring what post-surgery results would look like&#46; Finally&#44; an honest discussion with the patient about the advantages&#44; risks and limitations of each technique&#44; adapted to the specific situation of each case&#44; will facilitate the optimization of results in any of the surgical procedures to be applied&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Multiple surgical non-lens techniques have been used for treating presbyopia&#44; but none removes completely the need of using spectacles for near vision&#46; Moreover&#44; with the passage of time and the progressive deterioration of lens functions in patients&#44; the effectiveness of these techniques diminishes&#46; In addition&#44; many involve a compromise with far visual vision quality of operated eyes&#46; For these reasons&#44; patient selection and presurgery assessment are essential&#46; However&#44; many of said techniques improve patient refractive condition and&#44; by striking a reasonable balance between far and near vision&#44; they significantly improve dependence on optical correction and therefore quality of life&#46; More studies are necessary with more rigorous and standardized methods to assess changes in near vision of patients and with longer post-surgery follow-up in order to confirm the actual and practical usefulness of each technique described above&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have declared the absence of any conflict of interests at the commercial or financial level in relation to any of the products mentioned in this review&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres888070"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec874010"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres888071"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec874009"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Physiology of accommodation and presbyopia"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Surgical options for correcting presbyopia"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Corneal procedures"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Excimer laser monovision"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Multifocal corneal ablations &#40;commonly known in the literature as presbiLASIK&#41;"
            ]
            2 => array:3 [
              "identificador" => "sec0035"
              "titulo" => "Corneal implants &#40;CI&#41;"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Implants that alter the refraction index with bifocal optics"
                ]
                1 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Implants that change the corneal curvature"
                ]
                2 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Implants that function as a stenopeic hole"
                ]
              ]
            ]
            3 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Conductive keratoplasty"
            ]
            4 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Intra-stromal corneal incisions with femtosecond laser"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Scleral procedures"
        ]
        9 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflict of interests"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-02"
    "fechaAceptado" => "2017-04-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec874010"
          "palabras" => array:6 [
            0 => "Presbyopia surgery"
            1 => "Corneal inlays"
            2 => "PresbyLASIK"
            3 => "Multifocal laser"
            4 => "Monovision"
            5 => "Conductive keratoplasty"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec874009"
          "palabras" => array:6 [
            0 => "Cirug&#237;a de la presbicia"
            1 => "Implantes corneales"
            2 => "PresbiLASIK"
            3 => "L&#225;ser multifocal"
            4 => "Monovisi&#243;n"
            5 => "Queratoplastia conductiva"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presbyopia is the most prevalent refractive error&#46; With a progressive aging population&#44; its surgical correction is an important challenge for the ophthalmology community&#44; as well as the millions of patients who suffer from it&#44; and who are increasingly demanding alternatives to its correction with glasses or contact lenses&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A review is presented with a synthesized discussion on the pathophysiological theories of presbyopia and an updated and analytical description of the non-lens involvement surgical techniques used to treat presbyopia&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Corneal procedures include various types of corneal implants and photo-ablative techniques that generate a multifocal cornea&#44; or monovision&#46; Scleral procedures exert a traction on supralenticular sclera that supposedly would improve the amplitude of accommodation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">None of the techniques are able to completely eliminate the need for near -vision glasses&#44; but many of them manage to improve the refractive status of the patients&#46; More studies with rigorous and standardized methods and longer follow-up are needed to evaluate the changes in the near vision of the patients&#44; in order to corroborate the real and practical usefulness of many of these techniques&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La presbicia es el error refractivo m&#225;s prevalente&#46; Con el envejecimiento progresivo de la poblaci&#243;n&#44; su correcci&#243;n quir&#250;rgica supone un importante reto tanto para la comunidad oftalmol&#243;gica como para los millones de pacientes que la padecen y que cada vez demandan m&#225;s alternativas a su correcci&#243;n mediante gafas o lentes de contacto&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Esta revisi&#243;n presenta una discusi&#243;n sintetizada sobre las teor&#237;as fisiopatol&#243;gicas de la presbicia y una descripci&#243;n actualizada y anal&#237;tica de las t&#233;cnicas quir&#250;rgicas no cristalinianas utilizadas para tratar la presbicia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los procedimientos corneales incluyen varios tipos de implantes corneales y t&#233;cnicas fotoablativas que generan una c&#243;rnea multifocal&#44; o una monovisi&#243;n&#46; Los procedimientos esclerales ejercen una tracci&#243;n sobre la esclera supralenticular que supuestamente mejorar&#237;a la amplitud de acomodaci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ninguna de ellas permite eliminar completamente la necesidad de gafas para la visi&#243;n cercana&#44; pero muchas de ellas permiten mejorar la situaci&#243;n refractiva de los pacientes&#46; Son necesarios m&#225;s estudios&#44; con m&#233;todos rigurosos y estandarizados&#44; para evaluar los cambios en la visi&#243;n cercana de los pacientes&#44; y con un mayor seguimiento postoperatorio para corroborar la utilidad real y pr&#225;ctica de muchas de estas t&#233;cnicas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bilbao-Calabuig R&#44; Llovet-Osuna F&#46; T&#233;cnicas quir&#250;rgicas no cristalinianas para la correcci&#243;n de la presbicia&#46; Arch Soc Esp Oftalmol&#46; 2017&#59;92&#58;426&#8211;435&#46;</p>"
      ]
    ]
    "multimedia" => array:11 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 839
            "Ancho" => 2338
            "Tamanyo" => 166659
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ablation profile of the PresbyMax procedure &#40;Schwind-Amaris&#44; Germany&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 911
            "Ancho" => 2412
            "Tamanyo" => 157723
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ablation profile of the Supracor procedure &#40;Technolas Perfect Vision&#44; Germany&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1614
            "Ancho" => 2229
            "Tamanyo" => 334252
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Corneal implants types&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; courtesy of Dr&#46; Castillo&#59; published in&#58; Alfredo Castillo and Francisco Duch&#44; Cirug&#237;a refractiva corneal&#44; Gu&#237;as SECOIR de diagn&#243;stico y tratamiento 2015&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1744
            "Ancho" => 1616
            "Tamanyo" => 140329
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Flexivue Microlens Implant &#40;Presbia&#44; Inc&#46;&#44; USA&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Fig&#46; 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1271
            "Ancho" => 1570
            "Tamanyo" => 202512
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#40;a and b&#41; Raindrop Near Vision Inlay Implant &#40;ReVision Optics&#44; USA&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Fig&#46; 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 593
            "Ancho" => 950
            "Tamanyo" => 78375
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Kamra Implant &#40;Autofocus Inc&#46;&#44; USA&#41;&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Fig&#46; 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 488
            "Ancho" => 950
            "Tamanyo" => 72534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Conducted keratoplasty technique &#40;Viewpoint CK System&#44; Refractec Inc&#46;&#44; USA&#41;&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Fig&#46; 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 643
            "Ancho" => 800
            "Tamanyo" => 58056
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Intracor technique &#40;Technolas Perfect Vision&#44; Germany&#41;&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "fig0045"
        "etiqueta" => "Fig&#46; 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1037
            "Ancho" => 1744
            "Tamanyo" => 208312
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#8211;d&#41; Four fornix-based periotomies are performed&#44; ablation with erbium&#58;YAG laser 0&#46;5<span class="elsevierStyleHsp" style=""></span>mm posterior to the limbus and that 80&#37; of scleral thickness&#44; closing periotomies with bipolar tweezers&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "fig0050"
        "etiqueta" => "Fig&#46; 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 1271
            "Ancho" => 950
            "Tamanyo" => 120635
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">&#40;a and b&#41; scleral expanders&#58; silicon bands are inserted in 4 scleral channels to increase the distance between the lens equator and the overlying sclera&#44; producing ciliary muscle contraction&#46;</p>"
        ]
      ]
      10 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Corneal implant advantages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Corneal implant drawbacks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Additive effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Problems with oxygen permeability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reversible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Loss of contrast sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Repeatable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diminished entry of light&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Minimally invasive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diminished far vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Easily modifiable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Possible permanent corneal changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Can be combined with LASIK&#47;PRK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biocompatibility under question&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Can be implanted after lens surgery with previous monofocal IOL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires some neuroadaptation&#44; tolerance to combined vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Respects residual lens function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Halo&#47;Glare&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Femtosecond technology required&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Difficult procedure&#47;centering&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Previous emmetropia necessary&#44; thus requiring separate previous surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diminishing efficacy with presbyopia progression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1500836.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Corneal implant advantages and drawbacks&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:52 [
            0 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global vision impairment due to uncorrected presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;A&#46; Holden"
                            1 => "T&#46;R&#46; Fricke"
                            2 => "S&#46;M&#46; Ho"
                            3 => "R&#46; Wong"
                            4 => "G&#46; Schlenther"
                            5 => "S&#46; Cronje"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.126.12.1731"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Ophthalmol"
                        "fecha" => "2008"
                        "volumen" => "126"
                        "paginaInicial" => "1731"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19064856"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mechanism of accommodation in primates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Glasser"
                            1 => "P&#46;L&#46; Kaufman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0161-6420(99)00502-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "1999"
                        "volumen" => "106"
                        "paginaInicial" => "863"
                        "paginaFinal" => "872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10328382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "261&#8211;7&#59; discussion"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the lens diameter increase or decrease during accommodation&#63; Human accommodation studies&#58; a new technique using infrared retro-illumination video photography and pixel unit measurements"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;S&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Trans Am Ophthalmol Soc"
                        "fecha" => "1997"
                        "volumen" => "95"
                        "paginaInicial" => "7"
                        "paginaFinal" => "70"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age and the amplitude of accommodation measured using dynamic retinoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Leon"
                            1 => "J&#46;M&#46; Estrada"
                            2 => "M&#46; Rosenfield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/opo.12244"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmic Physiol Opt"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "5"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26353999"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Three-dimensional magnetic resonance imaging of the phakic crystalline lens during accommodation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;L&#46; Sheppard"
                            1 => "C&#46;J&#46; Evans"
                            2 => "K&#46;D&#46; Singh"
                            3 => "J&#46;S&#46; Wolffsohn"
                            4 => "M&#46;C&#46; Dunne"
                            5 => "L&#46;N&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.10-6805"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "3689"
                        "paginaFinal" => "3697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21296812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Massive increase in the stiffness of the human lens nucleus with age&#58; the basis for presbyopia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;R&#46; Heys"
                            1 => "S&#46;L&#46; Cram"
                            2 => "R&#46;J&#46; Truscott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Vis"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "956"
                        "paginaFinal" => "963"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15616482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cause and treatment of presbyopia with a method for increasing the amplitude of accommodation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Schachar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Ophthalmol"
                        "fecha" => "1992"
                        "volumen" => "24"
                        "paginaInicial" => "445"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1485739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human accommodative ciliary muscle configuration changes are consistent with Schachar&#39;s mechanism of accommodation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Schachar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.15-17452"
                      "Revista" => array:5 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2015"
                        "volumen" => "56"
                        "paginaInicial" => "6075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26393665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Success of monovision in presbyopes&#58; review of the literature and potential applications to refractive surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Jain"
                            1 => "I&#46; Arora"
                            2 => "D&#46;T&#46; Azar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surv Ophthalmol"
                        "fecha" => "1996"
                        "volumen" => "40"
                        "paginaInicial" => "491"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8724641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual outcomes of LASIK-induced monovision in myopic patients with presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Garcia-Gonzalez"
                            1 => "M&#46;A&#46; Teus"
                            2 => "J&#46;L&#46; Hernandez-Verdejo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2010.03.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2010"
                        "volumen" => "150"
                        "paginaInicial" => "381"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20542487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual quality after monovision correction by laser in situ keratomileusis in presbyopic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Alarcon"
                            1 => "R&#46;G&#46; Anera"
                            2 => "C&#46; Villa"
                            3 => "L&#46; Jimenez del Barco"
                            4 => "R&#46; Gutierrez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2011.03.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1629"
                        "paginaFinal" => "1635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21752590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical monovision and monovision reversal in LASIK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;D&#46; Reilly"
                            1 => "W&#46;B&#46; Lee"
                            2 => "L&#46; Alvarenga"
                            3 => "J&#46; Caspar"
                            4 => "F&#46; Garcia-Ferrer"
                            5 => "M&#46;J&#46; Mannis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "136"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16371770"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monovision surgery in myopic presbyopes&#58; visual function and satisfaction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Levinger"
                            1 => "O&#46; Trivizki"
                            2 => "R&#46; Pokroy"
                            3 => "S&#46; Levartovsky"
                            4 => "G&#46; Sholohov"
                            5 => "S&#46; Levinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/OPX.0000000000000002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Optom Vis Sci"
                        "fecha" => "2013"
                        "volumen" => "90"
                        "paginaInicial" => "1092"
                        "paginaFinal" => "1097"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24064524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monovision laser in situ keratomileusis for pre-presbyopic and presbyopic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Miranda"
                            1 => "R&#46;R&#46; Krueger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2004"
                        "volumen" => "20"
                        "paginaInicial" => "325"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15307393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monovision pseudophakia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Greenbaum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "1439"
                        "paginaFinal" => "1443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12160816"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of ocular dominance on binocular summation after monocular reading adds"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46; Handa"
                            1 => "K&#46; Shimizu"
                            2 => "K&#46; Mukuno"
                            3 => "T&#46; Kawamorita"
                            4 => "H&#46; Uozato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2005.01.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "1588"
                        "paginaFinal" => "1592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16129296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monovision in LASIK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;H&#46; Braun"
                            1 => "J&#46; Lee"
                            2 => "R&#46;F&#46; Steinert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2007.09.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2008"
                        "volumen" => "115"
                        "paginaInicial" => "1196"
                        "paginaFinal" => "1202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18061266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;Z&#46; Reinstein"
                            1 => "D&#46;G&#46; Couch"
                            2 => "T&#46;J&#46; Archer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "37"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19244952"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LASIK for myopic astigmatism and presbyopia using non-linear aspheric micro-monovision with the Carl Zeiss Meditec MEL 80 Platform"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;Z&#46; Reinstein"
                            1 => "T&#46;J&#46; Archer"
                            2 => "M&#46; Gobbe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20100212-04"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "23"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20205360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser in situ keratomileusis monovision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;B&#46; Goldberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2001"
                        "volumen" => "27"
                        "paginaInicial" => "1449"
                        "paginaFinal" => "1455"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11566531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Excimer laser photorefractive keratectomy for presbyopia&#58; 24-month follow-up in three eyes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Vinciguerra"
                            1 => "G&#46;M&#46; Nizzola"
                            2 => "G&#46; Bailo"
                            3 => "F&#46; Nizzola"
                            4 => "A&#46; Ascari"
                            5 => "D&#46; Epstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "31"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9531083"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Corneal multifocality with excimer laser for presbyopia correction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Alio"
                            1 => "F&#46; Amparo"
                            2 => "D&#46; Ortiz"
                            3 => "L&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2009"
                        "volumen" => "20"
                        "paginaInicial" => "264"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19537363"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presbyopia treatment by monocular peripheral presbyLASIK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;L&#46; Epstein"
                            1 => "M&#46;A&#46; Gurgos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "516"
                        "paginaFinal" => "523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19603619"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correction of presbyopia by technovision central multifocal LASIK &#40;presbyLASIK&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;L&#46; Alio"
                            1 => "J&#46;J&#46; Chaubard"
                            2 => "A&#46; Caliz"
                            3 => "E&#46; Sala"
                            4 => "S&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2006"
                        "volumen" => "22"
                        "paginaInicial" => "453"
                        "paginaFinal" => "460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16722483"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central PresbyLASIK for hyperopia and presbyopia using micro-monovision with the Technolas 217P Platform and SUPRACOR Algorithm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Saib"
                            1 => "M&#46; Abrieu-Lacaille"
                            2 => "M&#46; Berguiga"
                            3 => "C&#46; Rambaud"
                            4 => "F&#46; Froussart-Maille"
                            5 => "J&#46;C&#46; Rigal-Sastourne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20150727-04"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "540"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26248347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PresbyLASIK approach for the correction of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46;G&#46; Pallikaris"
                            1 => "S&#46;I&#46; Panagopoulou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICU.0000000000000162"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "265"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26058023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of the surgical options for the correction of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Gil-Cazorla"
                            1 => "S&#46; Shah"
                            2 => "S&#46;A&#46; Naroo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjophthalmol-2015-306663"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2016"
                        "volumen" => "100"
                        "paginaInicial" => "62"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25908836"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1474442213701790"
                          "estado" => "S300"
                          "issn" => "14744422"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical correction of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;S&#46; Davidson"
                            1 => "D&#46; Dhaliwal"
                            2 => "D&#46;R&#46; Hamilton"
                            3 => "M&#46; Jackson"
                            4 => "L&#46; Patterson"
                            5 => "K&#46; Stonecipher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2016.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "920"
                        "paginaFinal" => "930"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27373400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual outcomes and safety of a refractive corneal inlay for presbyopia using femtosecond laser"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;N&#46; Limnopoulou"
                            1 => "D&#46;I&#46; Bouzoukis"
                            2 => "G&#46;D&#46; Kymionis"
                            3 => "S&#46;I&#46; Panagopoulou"
                            4 => "S&#46; Plainis"
                            5 => "A&#46;I&#46; Pallikaris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20121210-01"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "12"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23311737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preloaded refractive-addition corneal inlay to compensate for presbyopia implanted using a femtosecond laser&#58; one-year visual outcomes and safety"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Baily"
                            1 => "T&#46; Kohnen"
                            2 => "M&#46; O&#8217;Keefe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2013.11.047"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "1341"
                        "paginaFinal" => "1348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25088635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bifocal refractive corneal inlay implantation to improve near vision in emmetropic presbyopic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Malandrini"
                            1 => "G&#46; Martone"
                            2 => "L&#46; Menabuoni"
                            3 => "A&#46;M&#46; Catanese"
                            4 => "G&#46;M&#46; Tosi"
                            5 => "A&#46; Balestrazzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2015.01.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1962"
                        "paginaFinal" => "1972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26603405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in keratometric values and corneal high order aberrations after hydrogel inlay implantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;J&#46; Whang"
                            1 => "Y&#46;S&#46; Yoo"
                            2 => "C&#46;K&#46; Joo"
                            3 => "G&#46; Yoon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2016.09.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2017"
                        "volumen" => "173"
                        "paginaInicial" => "98"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27697473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One-year safety and efficacy results of a hydrogel inlay to improve near vision in patients with emmetropic presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;B&#46; Garza"
                            1 => "S&#46; Gomez"
                            2 => "A&#46; Chayet"
                            3 => "J&#46; Dishler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20130129-01"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "166"
                        "paginaFinal" => "172"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23446012"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of a hydrogel inlay with laser in situ keratomileusis to improve vision in myopic presbyopic patients&#58; one-year results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;B&#46; Garza"
                            1 => "A&#46; Chayet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2014.05.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "306"
                        "paginaFinal" => "312"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25661123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of presbyopia in emmetropes using a shape-changing corneal inlay&#58; one-year clinical outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Whitman"
                            1 => "P&#46;J&#46; Dougherty"
                            2 => "G&#46;D&#46; Parkhurst"
                            3 => "J&#46; Olkowski"
                            4 => "S&#46;G&#46; Slade"
                            5 => "J&#46; Hovanesian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2015.11.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2016"
                        "volumen" => "123"
                        "paginaInicial" => "466"
                        "paginaFinal" => "475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26804761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term results of combined LASIK and monocular small-aperture corneal inlay implantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Igras"
                            1 => "R&#46; O&#8217;Caoimh"
                            2 => "P&#46; O&#8217;Brien"
                            3 => "W&#46; Power"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20160317-01"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2016"
                        "volumen" => "32"
                        "paginaInicial" => "379"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27304601"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;K&#46; Dexl"
                            1 => "G&#46; Jell"
                            2 => "C&#46; Strohmaier"
                            3 => "O&#46; Seyeddain"
                            4 => "W&#46; Riha"
                            5 => "T&#46; Ruckl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2014.05.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "566"
                        "paginaFinal" => "575"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25726504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Simultaneous corneal inlay implantation and laser in situ keratomileusis for presbyopia in patients with hyperopia&#44; myopia&#44; or emmetropia&#58; six-month results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Tomita"
                            1 => "T&#46; Kanamori"
                            2 => "G&#46;O&#46; Waring 4th"
                            3 => "S&#46; Yukawa"
                            4 => "T&#46; Yamamoto"
                            5 => "K&#46; Sekiya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2011.10.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "495"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22340607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical utility of the KAMRA corneal inlay"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;A&#46; Naroo"
                            1 => "P&#46;S&#46; Bilkhu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/OPTH.S89132"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Ophthalmol"
                        "fecha" => "2016"
                        "volumen" => "10"
                        "paginaInicial" => "913"
                        "paginaFinal" => "919"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27274194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay&#58; two-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46; Seyeddain"
                            1 => "W&#46; Riha"
                            2 => "M&#46; Hohensinn"
                            3 => "G&#46; Nix"
                            4 => "A&#46;K&#46; Dexl"
                            5 => "G&#46; Grabner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20100408-01"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "707"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20438021"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of presbyopia with conductive keratoplasty&#58; six-month results of the 1-year United States FDA clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;B&#46; McDonald"
                            1 => "D&#46; Durrie"
                            2 => "P&#46; Asbell"
                            3 => "R&#46; Maloney"
                            4 => "L&#46; Nichamin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2004"
                        "volumen" => "23"
                        "paginaInicial" => "661"
                        "paginaFinal" => "668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15448490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Femtosecond laser in situ keratomileusis versus conductive keratoplasty to obtain monovision in patients with emmetropic presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;G&#46; Ayoubi"
                            1 => "A&#46; Leccisotti"
                            2 => "E&#46;A&#46; Goodall"
                            3 => "V&#46;E&#46; McGilligan"
                            4 => "T&#46;C&#46; Moore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2009.12.035"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "997"
                        "paginaFinal" => "1002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20494773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparing the rate of regression after conductive keratoplasty with or without prior laser-assisted in situ keratomileusis or photorefractive keratectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Moshirfar"
                            1 => "E&#46; Anderson"
                            2 => "M&#46; Hsu"
                            3 => "J&#46;M&#46; Armenia"
                            4 => "M&#46;D&#46; Mifflin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-9233.102743"
                      "Revista" => array:6 [
                        "tituloSerie" => "Middle East Afr J Ophthalmol"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23248539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual outcomes and corneal changes after intrastromal femtosecond laser correction of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Menassa"
                            1 => "A&#46; Fitting"
                            2 => "G&#46;U&#46; Auffarth"
                            3 => "M&#46;P&#46; Holzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrs.2011.11.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cataract Refract Surg"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "765"
                        "paginaFinal" => "773"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Femtosecond laser correction of presbyopia &#40;INTRACOR&#41; in emmetropes using a modified pattern"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;C&#46; Thomas"
                            1 => "A&#46; Fitting"
                            2 => "G&#46;U&#46; Auffarth"
                            3 => "M&#46;P&#46; Holzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20121115-03"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "872"
                        "paginaFinal" => "878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23231738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrastromal femtosecond laser surgical compensation of presbyopia with six intrastromal ring cuts&#58; 3-year results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Khoramnia"
                            1 => "A&#46; Fitting"
                            2 => "T&#46;M&#46; Rabsilber"
                            3 => "B&#46;C&#46; Thomas"
                            4 => "G&#46;U&#46; Auffarth"
                            5 => "M&#46;P&#46; Holzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjophthalmol-2014-305642"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2015"
                        "volumen" => "99"
                        "paginaInicial" => "170"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25185255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes of intrastromal femtosecond laser presbyopia correction&#58; 3-year results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;C&#46; Thomas"
                            1 => "A&#46; Fitting"
                            2 => "R&#46; Khoramnia"
                            3 => "T&#46;M&#46; Rabsilber"
                            4 => "G&#46;U&#46; Auffarth"
                            5 => "M&#46;P&#46; Holzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjophthalmol-2015-307672"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2016"
                        "volumen" => "100"
                        "paginaInicial" => "1536"
                        "paginaFinal" => "1541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26903524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apparent corneal ectasia after bilateral intrastromal femtosecond laser treatment for presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Dukic"
                            1 => "M&#46; Bohac"
                            2 => "A&#46; Pasalic"
                            3 => "M&#46; Koncarevic"
                            4 => "M&#46; Anticic"
                            5 => "S&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "8"
                        "paginaFinal" => "1495"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Keratectasia after treating presbyopia with INTRACOR followed by SUPRACOR enhancement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Taneri"
                            1 => "S&#46; Oehler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/1081597X-20130620-02"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Refract Surg"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "573"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23799794"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age-related changes in human ciliary muscle and lens&#58; a magnetic resonance imaging study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Strenk"
                            1 => "J&#46;L&#46; Semmlow"
                            2 => "L&#46;M&#46; Strenk"
                            3 => "P&#46; Munoz"
                            4 => "J&#46; Gronlund-Jacob"
                            5 => "J&#46;K&#46; DeMarco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "1999"
                        "volumen" => "40"
                        "paginaInicial" => "9"
                        "paginaFinal" => "1162"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supraciliary contraction segments&#58; a new method for the treatment of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Z&#46; Tunc"
                            1 => "F&#46; Helvacioglu"
                            2 => "Y&#46; Ercalik"
                            3 => "G&#46; Baikoff"
                            4 => "S&#46; Sencan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0301-4738.97554"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Ophthalmol"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "116"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23552349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restoration of accommodation&#58; surgical options for correction of presbyopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Glasser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1444-0938.2008.00260.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Optom"
                        "fecha" => "2008"
                        "volumen" => "91"
                        "paginaInicial" => "279"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18399800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417301494/v2_201708291316/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5815"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000009/v2_201708291316/S2173579417301494/v2_201708291316/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301494?idApp=UINPBA00004N"
]
Indexed in:

Follow us:

Subscribe:

Purchase article

Indexed in:

Follow us:

Subscribe:

Purchase article

Subscribe to our newsletter
